The goal of this proposed R34 NIDCR Planning and Pilot Data Grant is to collect information that will support a later clinical trial on the effectiveness of a specially adapted dental environment for children who have difficulty tolerating oral care in the dental clinic. Within this project, two groups of children will be studied: children with autism spectrum disorders (ASD) and typically developing children, including those who are over- reactive to sensory stimulation. Commonly, such children exhibit anxiety and negative behavioral reactions when confronted with experiential aspects of dental visits such as exposure to bright fluorescent lighting, touch in or around the mouth, or the texture and smell of various oral care products. In the planned R34 grant, we will pilot test a sensory adapted dental environment (SADE) that has a strong potential to reduce anxiety and behavioral problems among the targeted groups of children. The SADE intervention includes such adaptations as dimmed lighting, exposure to soothing music, and application of a special vest which provides deep pressure sensations that are calming. If our preliminary assessment produces promising results, we will later more comprehensively test the intervention in a full-scale randomized clinical trial, which will be supported by a U01 award. The specific aims of the R34 grant are to promote the ability to conduct the future trial by: 1. Developing a manual for the SADE intervention and assessing the intervention's feasibility. 2. Collecting preliminary data on the intervention's effectiveness and potential cost-savings. 3. Pilot testing the recruitment strategy and assessment battery that will be used in the anticipated trial. 4. Developing the system of documents and data management for the future trial. 5. Generating the proposal for the U01 award to conduct the planned trial. Research participants will be 40 ethnically diverse children aged 6-12 years, 20 with ASD and 20 who are typically developing. Each child will undergo two dental cleanings four months apart: dental cleaning in a standard dental environment and dental cleaning in the sensory adapted environment. For each group of children (i.e., ASD and typically developing), the two conditions will be compared in their effects on anxiety and negative behavioral reactions, as measured by videotape coding, psychophysiological indices, and various rating scales. Because the planned research will contribute to safer, more efficient, less costly treatment, it has the potential to revolutionize clinic-based dental care for the growing population of children with ASD, as well as for typically developing children who have dental anxieties. The potential cost savings and contribution to child comfort are dramatic, as potentially more than one-fourth of all children may benefit from a sensory adapted dental environment. PUBLIC HEALTH RELEVANCE: Adapting the sensory environment in the dental office by modifying the sounds, sights, smells and tactile experiences has the potential to revolutionize clinic-based dental care for the growing population of children with Autism Spectrum Disorders, as well as for typically developing children who have dental anxieties. These adaptations will result in both decreased anxiety and negative behaviors during care. This will contribute to increased child comfort as well as safer, more efficient, and less costly treatment for a large population, as potentially more than one- fourth of all children may benefit from a sensory adapted dental environment.